Director, Shared Services Operations Support

Director, Shared Services Operations Support
Full-Time
Work Mode: Remote
About SCAN
SCAN Group is a not-for-profit organization dedicated to tackling the most pressing issues facing older adults in the United States. SCAN Group is the sole corporate member of SCAN Health Plan, one of the nation's leading not-for-profit Medicare Advantage plans, serving more than 270,000 members in California, Arizona, and Nevada. SCAN has been a mission-driven organization dedicated to keeping seniors healthy and independent for more than 40 years and is known throughout the healthcare industry and nationally as a leading expert in senior healthcare. SCAN employees are a group of talented, passionate professionals who are committed to supporting older adults on their aging journey, while also innovating healthcare for seniors everywhere. Employees are provided in-depth training and access to state-of-the-art tools necessary to do their jobs, as well as development and growth opportunities. SCAN takes great pride in recognizing our team members as experts in their fields and rewarding them for their efforts. If you are interested in becoming part of an organization that is innovating senior healthcare visitwww.thescangroup.org,www.scanhealthplan.com, or follow us on LinkedIn, Facebook, and Twitter.
The job
Supervises and directs the loading and timely maintenance of claims configuration, provider contracts, and related data within the designated systems, ensuring accuracy and compliance. Direct and oversee the Configuration Management team, EDI operations, Project Management, Business Analysis and Data Analysis to ensure systems and processes are operating efficiently and in accordance with Federal/State, Regulatory and Plan standards.
You will

• Oversee build and implementation of products, claims adjudication rules, pricing, fee schedules, letters, workflows,
• Understands upstream and downstream impacts to business and systems and recommend changes.
• Responsible for overseeing the accurate, compliant, efficient and timely configuration of claims business rules including provider payments, designing and loading contracts to support growing business needs.
• Direct team of business analysts and data analysts to develop and maintain reporting capabilities support of operational requirements and goals. Lead teams in the development and use of analytics in order to improve business outcomes.
• Oversee the development and maintenance of applications and utilities developed within the Shared Services department. Ensure adherence to regulatory and SCAN requirements. Enforce documentation and change management standards.
• Oversee and provide guidance for configuration activities to ensure systems are configured for optimal efficiency and meet business and regulatory requirements. Enforce documentation and change management standards.
• Oversee monitoring and validation of systems to ensure processes are completed as scheduled and in accordance with operational requirements. Triage and report issues to appropriate stakeholders and vendors.
• Oversee the architecture, design, coding, testing and implementation of changes for claims pricing, benefits and payments within the core claims payment system. Manage all new configuration requests and changes to existing configuration ensuring accuracy and timely.
• Manages EDI operations staff, oversees the day-to-day EDI operations, and assists in troubleshooting.
• Manages the testing of EDI transactions with Trading Partners and other certification authorities as mandated by the state and federal regulations.
• Maintains in-depth knowledge of HIPAA EDI 5010 TR3 technical specifications and the current HIPAA EDI rules from both technical and user perspectives.
• Support and participate in regulatory audits as needed.
• Proactively identify opportunities for process improvements. Make recommendations to appropriate stakeholders and actively manage through project delivery.
• Direct small, medium, and large projects and initiatives. Partner with cross functional teams to define and deliver solutions according to agreed-upon business requirements and timelines.
• Manage the work and relationship with designated vendors to ensure expected performance levels are met. Prioritize issues, provide implementation guidance, and apply budget oversight.
• Analyze and resolve escalated and/or complex issues in alignment with SCAN's values and code of conduct.
• Attend various committee meetings regarding regulatory requirements, compliance, member and provider issues, and strategic planning.
• Oversee and support all claims federal and state, and internal audit related activities by pulling required data.
• Comply with federal and state regulations by studying existing and new regulations, legislation, and laws. Keep abreast of any pertinent changes to legislation and regulations. Modify and/or develop internal policies and procedures to ensure ongoing compliance.
• Research, identify, and recommend industry best practices to support high-quality, cost-effective implementations and on-going program changes.
• Develop high performing teams by communicating job expectations; planning, monitoring, and appraising job results; coaching and counseling employees; initiating, coordinating, and enforcing systems, policies, and procedures.
• Maintain staff by recruiting, selecting, orienting, and training employees; maintaining a safe and secure work environment; developing personal growth opportunities.
• Maintain professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; participating in professional societies.
• Actively supports the achievement of SCAN's Vision and Goals
• Other duties as assigned.

Your qualifications

• Required: bachelor's degree/Master's Degree in Business Administration or equivalent experience.
• 6+ years healthcare operations and/or systems experience with Medicare and Medicaid.
• 4+ years management experience in a healthcare setting.
• 4+ years working with SQL and other reporting tools.
• Familiar with a variety of Medicare and Medicaid's concepts, practices, and procedures.
• Knowledge of HIPAA transaction sets, regulations/privacy laws.
• Consistently demonstrates self-motivation, integrity, initiative, and innovation in achieving results.
• Strong communication (written and verbal), influencing, negotiating, listening and interpersonal skills to effectively develop productive internal and external relationships.
• Strong presentation skills to effectively address diverse audiences.
• Proficient in software including SQL, Excel, Access, Word, PowerPoint, Alteryx, Tableau

What's in it for you?

• Base salary range: $125,400 - $200,600 annually
• An annual employee bonus program
• Robust Wellness Program
• Generous paid-time-off (PTO)
• Eleven paid holidays per year, plus 1 additional floating holiday
• Excellent 401(k) Retirement Saving Plan with employer match.
• Robust employee recognition program
• Tuition reimbursement
• A work-life balance
• An opportunity to become part of a team that makes a difference to our members and our community every day!

We're always looking for talented people to join our team! Qualified applicants are encouraged to apply now!
At SCAN we believe that it is our business to improve the state of our world. Each of us has a responsibility to drive Equality in our communities and workplaces. We are committed to creating a workforce that reflects our community through inclusive programs and initiatives such as equal pay, employee resource groups, inclusive benefits, and more.
SCAN is proud to be an Equal Employment Opportunity and Affirmative Action workplace. Individuals seeking employment will receive consideration for employment without regard to race, color, national origin, religion, age, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender perception or identity, age, marital status, disability, protected veteran status or any other status protected by law. A background check is required. #LI-JR1
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. 41 CFR 60-1.35(c)